In the present "era of adherence" of the HIV/AIDS epidemic, questions are being raised about the ability of legal drug users and other marginalized groups to adhere to complex regimens of highly active antiretroviral therapies (HAART). This three-year project addresses these questions by describing patterns of and influences on adherence to HAART for HIV + active drug users over time. The immediate goal is to add to existing knowledge of practical strategies for supporting adherence, by devising strategies that drug users, their clinicians, and their social intimates can use in designing individualized plans for adherence to HAART. Long-term objectives are to facilitate access and maximize therapeutic benefit from HAART for individual drug users, and reduce the public health risk posed by the transmission of HAART-resistant strains of HIV. The project uses a social course perspective drawn from studies of chronic illness in medical anthropology as a conceptual framework. Social influences on adherence to HAART (social course) will be examined over time in a randomly selected group of 50 active illegal drug users with HIV/AIDS. Study participants will be drawn from the patient population of The Zinberg Clinic, a multidisciplinary primary care facility at The Cambridge Hospital (Cambridge, MA) that serves persons with HIV and their families. Data collection will consist of six in-depth, qualitative interviews conducted at two-month intervals with each study participant (Total 300). Interview data will be supplemented by information extracted from medical records. Data analysis will use grounded theory methods and chart construction techniques adapted from life course research to develop two types of descriptive categories: adherence course categories, and social influence categories. These categories will serve as the basis for formulating and assessing the feasibility of patient focused, clinician-focused, and other strategies for supporting adherence to HAART among active users of illegal drugs.